Provider Demographics
NPI:1982023669
Name:LIAUTAUD, MELISSA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LIAUTAUD
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DUNDEE RD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2437
Mailing Address - Country:US
Mailing Address - Phone:847-498-5437
Mailing Address - Fax:847-598-5438
Practice Address - Street 1:3100 DUNDEE RD
Practice Address - Street 2:SUITE 704
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2437
Practice Address - Country:US
Practice Address - Phone:847-498-5437
Practice Address - Fax:847-598-5438
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-14-15820103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst